In Charge and On Time
ABSTRACT
Communication failure has been cited as the most frequent cause of
medical errors.7 The Joint Commission recommends standardizing
handoff to ensure patient safety and improve outcomes.3
Impacting patient care through improving time management
DeAnna Middleton, RN; Janet Michaels, RN; Jody Wasielewski, BSN, RN;
Lisa Chismar, RN; Mary Jo Kocan, MSN, RN, CNRN
University of Michigan Hospital
Neurosurgical Intensive Care Unit
Our handoff process includes a group charge report to give information
necessary for making assignments, consisting of a brief overview of
current patients, admissions and discharges. This is followed by a more
in depth report from the bedside nurse and validation of the
neurological assessment by the oncoming and off-going nurses. We
created a computerized spreadsheet for group charge report detailing
pertinent patient information on a standardized template in an effort
to improve time management.
POSTER OBJECTIVES
II.
III.
•
•
CONCLUSION
This new tool decreased the amount of time spent in group
charge report from 20 minutes to less than 5 minutes. This
improvement in time management has:
• Our team created a computerized and standardized template
for group report with defined categories of information felt to
be the essential items needed for making assignments during
group charge report. The grey areas are formatted for text
input by the off-going charge nurse.
INTRODUCTION
Encouraged review of patient care
orders and vital signs for patient
safety during bedside report.
Staff expressed dissatisfaction with our unit’s process for change of shift
report. They felt they were often delayed in doing initial patient
assessments because of group charge report. This was also causing them
to stay beyond the end of their scheduled shift to give report to the
oncoming nurse. In our unit we are given 30 minutes to complete the 3
part process of our shift report. Our time was being inefficiently spent in
group charge report causing nurses to rush through bedside nursing
report and skip bedside neurological co-assessments in an effort to leave
on time at the end of their shift. A group was formed to look at ways to
improve time management. The objective was to improve staff
satisfaction by decreasing incidental overtime secondary to the lengthy
reporting process.
Provided time for bedside neuro
exams to be done more frequently
and consistently.
Allowed for introduction and goal
setting with patient’s and family to
promote family centered care.
Decreased risk of information being
missed due to staff member rushing
through report.
Improved staff preference
Decreased average number of
incidental OT hours for a yearly
savings of $3,750.00.
EVIDENCE
16
14
No
opinion
14.7
15.3
15.8
14.9
13.6
12
10
No
8
5.4
6
3.9
3.6
3.1
4
1.8
Yes
2
0
6
8
10
12
14
16
Jun-10
Jul-10
Aug-10
Sep-10
Old
Neutral
New
REFERENCES
Q: "I perform(ed) bedside neuro exams more often since implementation of the new charge reporting system.
4
71%
DECREASED UNIT OVERTIME
INCREASED NEURO EXAM COMPLIANCE
2
23%
 Continue to gather data on patient safety and quality indicators.
 Perform quarterly audits to ensure continuous quality improvement
and to meet evolving unit needs.
 Encourage other unit and areas to implement small changes to
make a significant impact on patient care and safety.
Effectiveness was measured using two methods. Nursing satisfaction and compliance performing
the bedside neurological co-assessment were measured using a self-reported survey. A
comparison of overtime data before and after implementation of the new group reporting process
was used to determine if staff were able to leave on time at the end of their shift.
0
6%
FUTURE DEVELOPMENT
SURVEY RESULTS
# Hours
Although the need for improving communication around handoffs in
healthcare is well documented, there is little evidence on effective tools
to do this. The Joint Commission recommendations for improving handoff
communication include: standardizing critical content, developing
standardized tools and forms and allowing opportunity for questions.3 A
review of handover practices in healthcare identified that although the
ideal process for nursing handovers has yet to be identified, technological
solutions need to be explored.1 Nelson and Massey4 found that using an
electronic template for change of shift report resulted in improved
relevance of information transmitted, as well as reduced end of shift
overtime. Performing shift report at the patient’s bedside has been shown
to improve patient satisfaction with their nursing care as well as staff
satisfaction with the pertinence of information received in shift report.5
"LOVE IT!!!"
"Rarely was ever out on time and also rarely
documented my OT(with old system)“
"Always felt rushed(with old system)"
"Definitely NOT able to perform neuro exam
(with old system)“
"With the old system the majority of staff did not
leave on time, but most didn't document 5-10-15
minutes of OT. 12 hours is long enough and report
shouldn’t take 45minutes.“
"With the old system, I'd run into people waiting to
leave after report and they were skipping neuro exams.
“I have more time to spend at the bedside giving report
and checking the neuro exam then wasting time in charge
report getting info I didn’t need.
Increase fiscal responsibility
INTERVENTION
Provide 2 reasons why nursing report is important to quality
patient care.
State 3 barriers to effective communication of patient
information during change of shift report.
Identify 4 positive outcomes from introducing a standardized
template for change of shift report.
•
•
PROJECT
OBJECTIVES
Increase staff satisfaction
•
•
•
Increase patient safety by
increasing compliance with
bedside neuro exams
Improve the quality of bedside
nursing report
We believe that by streamlining group charge report we have improved
the quality of our handoff process. The majority of time is now spent
getting bedside report versus group charge report. Staff surveys show
improved compliance with jointly performing the bedside neurological
exams. Incidental overtime related to late report has also been
reduced, which has increased staff satisfaction by allowing staff to
leave on time.
I.
STAFF FEEDBACK
Oct-10
Nov-10
Dec-10
Jan-11
Feb-11
Mar-11
BIBLIOGRAPHY
1) Matic, J., Davidson, P., Salamonson, Y. (2010).
Review: Bringing Patient Safety to the Forefront through Structured Computerization during Handover.
Journal of Clinical Nursing. 20, 184-189.
2) Nelson, B., Massey, R. (2010).
Implementing an Electronic Change-of-Shift Report Using Transforming
Care at the Bedside Processes and Methods.
The Journal of Nursing Administration. 40(4), 162-168.
3) The Joint Commission Center for Transforming Healthcare.
(2011). Standards and National Patient Safety Goals.
Retrieved from:
http://www.centerfortransforminghealthcare.org/
projects/about_handoff_communication.aspx on 2/28/2011.
4) www.uofmhealth.org
5) Anderson, C., Mangino, R. (2006)
Nursing Shift Report: Who Says You Can’t Talk in Front of the Patient?
Nursing Administration Quarterly. 30(2), 112-122
6) Wilson, M. (2007)
A Template for Safe and Concise Handovers
Medsurg Nursing. 16(3), 201-206
7) Dufault, M., Duquette, C., Ehmann, J. (2010)
Translating an Evidence-Based Protocol for Nurse-to0Nurse Shift Handoffs
Worldviews on Evidence-Based Nursing. Second Quarter, 59-75
Contact Information
DeAnna R. Middleton, R.N.
deakit@umich.edu
734-936-6520